=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639892896
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | POWERFUL PURPOSE PSYCHOLOGICAL & SUPPORT SERVICES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2022
-----------------------------------------------------
Last Update Date | 11/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1618 US 1 HWY
-----------------------------------------------------
City | YOUNGSVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27596-9219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-394-8900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 SOUTHTOWN CIR
-----------------------------------------------------
City | ROLESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27571-9573
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-394-8900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOLOGIST
-----------------------------------------------------
Name | DR. TRUTINA-MARIA SPOONAMORE
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 919-500-3398
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC2200X
-----------------------------------------------------
Taxonomy Name | Clinical Child & Adolescent Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------